Collette Lee King, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

10843 Issued in CA

Practice address

29525 Canwood St
Suite 300
Agoura Hills, CA 91301-4233

Phone

(818) 706-2477

Fax

(818) 706-2368

NPI assigned

Mar 11, 2007

Last updated

Jun 1, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Providence Medical InstituteGroup PAC ID 5991609737, 303 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adventist Health Simi Valley Hospital, Simi Valley, CA, CCN 050236
• UCLA West Valley Medical Center Hospital, West Hills, CA, CCN 050481

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Providence Medical Institute

  dba Providence Little Company of Mary Medical Institute

  • Family Medicine Physician
  • Torrance, CA
  • NPI 1417915760
  Medicare reassignment Care Compare group NPD
• Providence Medical Institute

  dba Providence Little Company of Mary Medical Institute

  • Family Medicine Physician
  • Torrance, CA
  • NPI 1235182569
  NPD
• Providence Medical Institute

  dba Providence Little Company of Mary Medical Institute

  • Family Medicine Physician
  • Torrance, CA
  • NPI 1760425862
  NPD
• Affiliates in Medical Specialties Medical GRP. Inc

  • Internal Medicine Physician
  • West Hills, CA
  • NPI 1730195447
  NPD (past)
• Prime Healthcare Centinela, LLC

  dba Centinela Hospital Medical Center

  • General Acute Care Hospital
  • Inglewood, CA
  • NPI 1336328244
  NPD (past)
• Providence Health System - Southern California

  • Psychiatric Hospital Unit
  • San Pedro, CA
  • NPI 1154349371
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Regents Univ of Calif Los Angeles

  dba UCLA West Valley Medical Center

  • General Acute Care Hospital
  • West Hills, CA
  • NPI 1801653969
  Care Compare affiliation
• Simi Valley Hospital and Health Care Services

  • General Acute Care Hospital
  • Simi Valley, CA
  • NPI 1063495190
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622505600000",
    "number": "1194857656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29525 CANWOOD ST",
            "address_2": "SUITE 300",
            "city": "AGOURA HILLS",
            "state": "CA",
            "postal_code": "913014233",
            "telephone_number": "818-706-2477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29525 CANWOOD ST",
            "address_2": "SUITE 300",
            "city": "AGOURA HILLS",
            "state": "CA",
            "postal_code": "913014233",
            "telephone_number": "818-706-2477",
            "fax_number": "818-706-2368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KING",
        "first_name": "COLLETTE",
        "middle_name": "LEE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-11",
        "last_updated": "2021-06-01",
        "certification_date": "2021-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "10843",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cking191876@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "29525 Canwood St",
            "address_2": "Suite 300",
            "city": "Agoura Hills",
            "state": "CA",
            "country_code": "US",
            "postal_code": "913014233",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Kim Kmetz, MFT
• Jacklyn Kokuashvili
• Carla E Korn, LMFT

• Family Nurse Practitioner in Agoura Hills, CA
• Providers in Agoura Hills, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.